Archive for June 2012

David Cameron this week delivered a speech on his welfare reform proposals. We know he is championing the ‘big society’ and that ‘we’re all in it together’, though this latter phrase seems to be missing from his vocabulary recently.

We know too, that no matter how big how capacity to help, how large our compassion might be, sometimes help has to be paid for to get the best results.

I can clean my car, change the oil, I’ve even managed a spare wheel in my time, but don’t ask me to carry out a service. It’s beyond what I can do, even though it would be nice to save on the garage bills.

Today I read a story which made me want to help the learning disabled more, but realistically I know I cannot.

As an association, we really don’t do politics and we are happy to work with all parties for the benefit of those we serve in the care sector.

But it’s a fact that political decisions are causing benefits to be cut. Some of these benefits are essential if our leaning disabled people are going to live more independent, fulfilled lives.

Many have already lost day care services and centres throughout the UK have been closed as funds dry up.

Poor funding equals less professional involvement, effectively making the ‘big society’ morally responsible to offer the services which have been withdrawn.

But will this policy-by-default tactic really work?

‘Jane’ has lived with her mum for 47 years and at last is striking out on her own.

She has Down’s syndrome and her mother has helped her to set up in supported living and learn to use the bus.

She does voluntary work in a charity shop, enjoys a cake-making group, and engages in other activities.

But Jane received a letter from the Department for Work and Pensions, telling her that she may be getting too much benefit and that she had to go to see someone about it.

This was not through an advocate, friend or relative who could have explained it and support her.

She worried, told her mum, and they both worried until they could both talk to someone who explained that “everyone got a letter” and she would be alright.

Great news – nothing is changing for ‘Jane’.

These events leave me pondering just how many more learning disabled are experiencing the same worries as ‘Jane’ and her elderly mum. And I am concerned too, that their independent living rights may be compromised in the benefits purge. Exactly how the ‘big society’ is supposed to help here, I don’t know.

In the same week ‘Jane’ was bullied by two drunks on a bus who demanded money from her. The CCTV evidence led to police tracing the men.

‘Jane’ was terrified.

If it is a reflection of a growing belief that those who need care and support somehow do not deserve it, then we are indeed in trouble as a society – ‘big’ or otherwise.

Local care associations from around the country are set to meet in Dudley on July 12 to discuss the current fees crisis.

Judicial reviews have failed to ease the funding situation for the private sector and it is hoped the meeting will be able to establish a way forward as fees continue to lag behind the inflation rate.

The meeting, which I will chair, comes as new research from Laing & Buisson reveals that councils have cut back on schemes that reward high quality homes.

In the past local authorities have offered higher payments for the delivery of excellent care but as the squeeze has taken its toll on these rewards.

“Less than one in five councils said they were making additional payments to care homes that met quality standards or docking money from those that fell short, “ according to the report.

Two years ago three-quarters said that they varied fees according to quality.

Council fee rates for older people’s care homes have increased by 1.6 per cent this year. Calculations by L&G state the figure for care homes’ rate of inflation is 2.5 per cent.

I find it incredulous that despite the judicial review rulings we are still battling to level peg with inflation.

In a number of judicial review decisions, the courts have ruled that councils must adequately consult with providers in setting fees and show how their rates meet the cost of care.

The report goes on to spell out more gloom. They calculated that fees had fallen in real terms by 4.8 per cent since 2010-11 and with margins for working profit already very small, it can only mean more trouble.

While it expected many care providers to seek to expand their base of private-paying clients, it said this option was also limited for many providers because of their geographical location.

We have all asked why the care system is in crisis and there have been some economic rumblings from council officers in the past. But we all know the answer, don’t we? The bed fees paid to members are simply not meeting the true cost of care.

I had hoped Government intervention might have forced a major shift in thinking, but no.

There has to be sometime soon a long-term solution coming from Whitehall, but until then, at local level, we’ll continue to try and find the answers the holders of the purse strings refuse to seek. Just how complacent these people are is overwhelming. How much louder can we shout? Fore sure, the problem is not going to go away.

The care industry is in the news again – and, once again, for all the wrong reasons. I crave good news about our sector.

Yesterday we presented with the fact that almost half of residential care homes for people with learning disabilities failed to meet Care Quality Commission standards.

The Commission said 48 per cent of the 150 locations inspected were non-compliant in terms of whether patients “experienced safe and appropriate care, treatment and support and whether they [were] protected from abuse”.

I find myself feeling angry that there’s more band news, when there’s so much good being done by providers. But at the same time, I am fully aware we need the BBC Panorama revelations that prompted the inspections, so that problems can be exposed.

The unannounced inspections were launched after the terrible business at Winterbourne View, a private assessment and treatment centre in Bristol, last year.

CQC found that NHS locations were twice as likely to be compliant as private hospitals.

Some with three per cent of independent providers fulfilled standards required compared with 68 per cent of those run by the state.

It was the fact that the watchdog raised concerns over the lengths of stays in these places which troubled me most.

It was reported that Bernadette Hanney, the CQC’s project lead, said that in one case an adult had been kept in a location for 17 years.

That surely is unacceptable. The reports went on to tell us that in two-thirds of cases people had been there for three or more years and one poor individual have suffered bullying by other patients for six months – with nothing being done to end it.

There must be a better way but I wouldn’t pretend to have the answers.

At 27 locations the safeguarding concerns were reported to the local authorities.

Professor Eric Emerson from the Centre for Disability Research at Lancaster University was reported in The Guardian as saying: “The programme of inspection undertaken by CQC provides clear evidence of the extent to which people with learning disabilities who become patients in assessment and treatment units are being failed by the current system.”

Why is it that society’s most vulnerable people groups are the ones who appear to be let down so spectacularly?

The response from Paul Burstow, the social care minister, is as interesting as it is mysterious.

He would be encouraging the CQC to continue its surprise inspections and that there would be 14 “national actions” to ensure that the events of last year at Bristol did not happen again.

The Association awaits with interest to study the 14 measures he has in mind.

I would dearly love to make some positive contribution in this blog about the Commission’s findings. I am left saying once again a well-rehearsed phrase: “Not all carers are bad and only a small minority of homes fail CQC inspections.” Has training failed, has compassion run out, is funding not enough, who knows?

My comments sadly just don’t seem enough to offset the untold damage these kind of findings do to our sector. They demoralise and erode public trust. Don’t get me wrong we need the public exposure about the failings. But we desperately need to reaffirm all of the good, kind, compassionate work and care that is undertaken, not just for the learning disabled, but for other needy people too.

We have just come to the end of Carers Week where many of the WMCA members have marked out clearly to those who want to see the important role of ‘the carer’.

The national Press has recognised the hugely significant work so many of these unpaid, unsung heroines and heroes, with whom we regularly come into contact.

They are often worn out, isolated, frustrated that they are under resourced to cope and not least, depressed. Having said that, their commitment to tend to their loved-ones is also often exemplary.

The findings published during this last week leave me both perplexed and heartened. I read in one article it was like living in a “parallel world.” And I understand it well.

I too, cared long-term for both my father and mother. It’s a role which sometimes is hard to define as the demands can change so rapidly and life is lived without spontaneity.

But I see too, a great initiative in Worcester aimed at helping careres.

Our industry is supported equally on the pillars of funding and goodwill.

It is estimated that one in three adults will become a carer in the next 10 years. Some 20 per cent will care for more than 50 hours a week, and most doing so without outside assistance. Yes, no help at all.

A survey released during Carers Week showed that many carers are feeling the strain. The Guardian newspaper used the word “buckling” under the pressure.

But evidence suggests too that when carers are supported early in their role, crises can be avoided. Our problem now is that all support has a ledger figure and we here it so often: “There’s just no budget available.”

It’s ironic that so much medical focus is on the one being cared for, but little on the one providing care. I am, however, heartened that GPs are now aware of the need to support carers and reduce referrals to secondary and hospital care.

The Royal College of General Practitioners (RCGP) has been commissioned to champion the needs of carers. That’s wonderful, but I fear there is a lot of work to be done to get the message ‘out there’.

Signposting help streams needs to be addressed. The eclipsing nature of caring can almost shut down one’s ability to think that outside resources could be available. And I’m not surprised. The news is full of cutbacks, closures, austerity and . . . more gloom. No wonder people lose the perception of available help.

As well as the more obvious Carers UK and the Carers Trust, there are other agencies that offer carer support, including Age UK and Action for Children as well as illness-specific groups.

In Worcestershire, a countywide GP-based carer support service was launched last week following a successful pilot in three areas.

I quote the Guardian: “The service was commissioned and will be provided by Worcestershire Association of Carers, which will place carer support advisers within surgeries, providing one-to-one support for carers and signposting them to appropriate services. There will be 6.5 full-time advisers working across 68 GP practices.”

Helen Garfield, project officer at the joint commissioning unit at Worcestershire county council acknowledges is quoted: “We have expanded our 24-hour phone information and support helpline for carers, and increased our flexible breaks service, which will allow more carers to receive up to four hours per week replacement care.

“It was a delicate balancing act,” she says, between funding the advisers and building the capacity of countywide services that could experience a huge rise in demand.

How I wish our society values were different. This is a splendid initiative but I know funding will always be an issue.

As professional carers we are undervalued – we only have to see the unwillingness of local authorities to up bed rates to more realistic levels – so it stands to reason, doesn’t it, that unpaid carers are treated the same way.

I have survived my carer’s role. I have a home, career, prospects and healthy social life. I have been lucky,

Sadly, so many careres, who have this ‘duty’ thrust upon them, lose homes, pensions, life-savings, jobs, friends, dignity and worth. Their lifelines are the much-needed windows of professional support and respite – two of the very things which, because of financial restraints, are now being reduced and denied.

Carers Week has come and gone. Let’s hope we can keep in our memory some of the lessons it needs to teach us.

Issues within Sandwell and Birmingham continue to keep us on out toes, with fees being the main agenda topic.

I’ve outlined a brief review, but there’s more information on our website. Feel free to leave your feedback on this blog. It’s your opportunity to have your say.

Birmingham

Information on the new tendering process in Birmingham continues to be in short supply but the city council has promised to ensure that there is up to date information on their website.

As many of you already know, we have asked Birmingham about a care homes fee increase, but we are still waiting for a response from the new council.

Sandwell

We are also still talking with Sandwell about fees and the implications of current economic squeeze. Currently we have a new offer from Martin Samuels that has been sent out with the last newsletter. You can also find a copy on the Sandwell page on our web site: http://www.westmidlandscare.org.uk/members/pages/2353/sandwell.

Following this last offer we stopped talking about fees to discuss the other issues which impact on the cost of running a care home.

Matters discussed include training, infection control and contracts.

We plan to stage a series of events to help care providers in Sandwell, starting next month. We will keep you informed as soon as dates are booked.

For dementia care providers we are setting up a community of practice, which will give all providers a chance to have a coffee and discuss issues.

An experienced tutor will be on hand and snippets of training will be given.

The sessions will be short and informative – the first being in September.

Help us negotiate fees

The association has set a system for you to access the average prices paid within your areas, so you can compare your cost to it.

Unison has been making headlines again – the kind the government would like not to appear.

Reported in the Guardian yesterday, the union has published a new report highlighting widespread closures and local authority cuts to day centres.

The result, says the newspaper article: Crisis in care for the elderly.

A survey of social care workers in more than 100 areas of England, Wales and Scotlandfor the union – conducted by the University of Birmingham’s health services management centre – reveals that 57 per cent have seen day centres close down.

And it’s the services for the elderly which have been hardest hit.

People with learning and physical disabilities follow them.

The survey notes increases in charges for attendance, meals and transport, with some places no longer providing meals.

For some of those surveyed fees had topped £50 a day.

Understandably, Unison said, according to the Guardian, “closing day centres was a false economy because they provide much-needed respite for carers, as well as monitoring and improving the physical and mental health of some of the UK’s most vulnerable people.”

Heather Wakefield, Unison’s head of local government, was quoted: “The coalition’s cuts and austerity agenda is hitting some of the UK’s most vulnerable people, and another round of budget cuts means this situation will only get worse.”

Let me make it clear, the WMCA is not a politically driven organisation and we are happy to work alongside all parties to achieve the best possible outcomes of care.

But this latest news does concern me. We have worked long and hard to recover for so many elderly some kind of social interaction; to help make lonely people feel valued and to ensure the marginalized are accepted into society.

The day centre service is invaluable as it guards against all of these things. And we all know (I think) that loneliness is a killer.

And then there’s the issue of already hard-pressed carers. Many now face 24/7 programmes of diligence. Who can possibly sustain that?

I can only hope the priorities for those who are most marginalised, either by age, illness or disability, change very soon. There’s a limit to what care we can deliver in public, private and charity sectors without the necessary funding. Whether we like it or not, it’s hard cash that is the oil of the caring engines.

The Commission on Improving Dignity in Care for Older People has released a new report calling for a ‘major cultural shift’ in residential homes and hospitals. Why? To tackle issues of poorly delivered care and compromised dignity.

It is both heartening and appalling that such a report is needed in these enlightened times.

Heartening, because dignity and care are key pillars in any care model and should be rigorously policed. And appalling, because there should not be the need in a civilized society for such actions.

The Commission, a group established between the NHS Confederation, charity Age UK, and the Local Government Association, is looking to establish ‘basic rules’ for care providers to pursue.

A great concept, if not a legally binding one.

Every NHS and care home chief executive in England will get a copy and later in the year will be provided with an action detailing practical measures to achieve the ‘cultural shift’.

Director of internal affairs at the Alzheimer’s Society, Andrew Chidgey, is reported as saying: “It is vitally important that anyone in hospital or a care home can be confident they will be treated with dignity and receive good quality care.

“People with dementia account for a quarter of hospital inpatients and two-thirds of care home residents. With half of people with dementia leaving hospital in worse health than when they arrived, we know that often the care is currently not good enough. Lack of training in dementia is a major reason behind this.

“We hope that the recommendations in ‘Delivering Dignity’ will help improve care by offering practical advice to hospitals and care homes, helping them to improve standards and change attitudes towards people living with dementia.”

As an Association we would endorse his comments. So many of you carers know only too well the shortfall in care that is delivered to dementia sufferers in hospitals. Dementia is a hugely time-demanding problem – time which so frequently is in short supply.

It’s impossible to lay blame with hospital nurses here as we know many of them share the same frustrations as we have on funding restrictions, resources and staffing levels.

A cultural shift is indeed needed. Sadly, culture is inextricably linked to wealth – which is currently sadly lacking in then care sector. Perhaps some of the shift needs to be a political willingness to channel more monies into this badly needed care education programme. Over to you Mr David Cameron.